甘油三酯-葡萄糖改良指数与无标准可修饰心血管危险因素人群主要不良心血管事件关联的队列研究

Aü cohort study on the association between modified triglyceride-glucose indices and major adverse cardiovascular events in the population without standard modifiable risk factors

摘要:

目的]评估甘油三酯-葡萄糖指数(TyG)及其改良指数——TyG-体质指数(TyG-BMI)、TyG-腰围(TyG-WC)、TyG-腰围身高比(TyG-WHtR)与无标准可修饰心血管危险因素(SMuRF)人群主要不良心血管事件(MACE)的关联,并筛选相对更优的候选预测指标。 [方法]纳入来自北京一项动脉粥样硬化队列调查的参与者,采用单因素与多因素Cox回归分析检验TyG改良指数与MACE的关联,并通过阈值分析和亚组分析进一步探索TyG-WHtR与MACE的相关性。 [结果]共纳入1 172名无SMuRF参与者。与女性相比,男性参与者年龄更大,TyG改良指数水平及MACE发生率均更高。在TyG及其改良指数中,仅TyG-WHtR在调整混杂因素后仍与MACE显著相关(HR＝2.431,95%CI:1.089～5.425,P＝0.030)。TyG-WHtR与MACE之间呈非线性关联(似然比检验P＝0.033),且存在阈值效应:当TyG-WHtR≥4.124时,其与MACE呈正相关(HR＝7.37,95%CI:2.35～23.09,P＜0.001)；低于该阈值时无显著关联。亚组分析结果显示,TyG-WHtR与MACE的关联在男性参与者中较女性更为显著(男性:HR＝13.95,95%CI:3.55～54.81,P＜0.001；女性:HR＝1.12,95%CI:0.36～3.47,P＝0.844；交互P＝0.008)。 [结论]TyG-WHtR与无SMuRF人群的MACE呈显著正相关,尽管亚组分析提示该关联在男性群体中更为显著,但受限于本研究男性样本量偏小,这一结论仍需在性别比例更均衡的队列中进行进一步验证。

Abstract:

Aim To evaluate the association between triglyceride-glucose index (TyG) and its modified indices:TyG-body mass index (TyG-BMI), TyG-waist circumference (TyG-WC), TyG-waist-to-height ratio (TyG-WHtR) and major adverse cardiovascular events (MACE) in the population without standardized modifiable risk factors (SMuRF-less), and screen for relatively better candidate predictive indicators. Methods Participants from an atherosclerosis cohort survey in Beijing were enrolled. Univariable and multivariable Cox regression analyses were performed to examine the associations between modified TyG indices and MACE. Threshold analysis and subgroup analyses were further conducted to explore the correlation between TyG-WHtR and MACE. Results A total of 1 172 SMuRF-less participants were included. Compared with females, male participants were older and exhibited higher modified TyG indices and MACE incidence. Among TyG and its modified indices, only TyG-WHtR remained significantly associated with MACE after adjustment for covariates (HR＝2.1,5%CI:1.089～5.425, P＝0.030). Notably, a nonlinear association with a threshold effect was observed between TyG-WHtR and MACE (P for likelihood ratio test＝0.033). When TyG-WHtR was ≥4.124, it was positively correlated with MACE (HR＝7.7,5%CI:2.35～23.09, P＜0.001), whereas no significant association was observed below this threshold. Subgroup analyses indicated that the association between TyG-WHtR and MACE was stronger in male participants than in female participants (males:HR＝13.5,5%CI:3.55～54.81, P＜0.001; females:HR＝1.2,5%CI:0.36～3.47, P＝0.844; P for interaction＝0.008). Conclusions TyG-WHtR was significantly positively correlated with MACE in the SMuRF-less population, although subgroup analysis suggests that this association is more significant in the male population. However, due to the small sample size of males in this study, this conclusion still needs to be further validated in a more gender-balanced cohort.